Continuous positive airway pressure as an accurate marker for non-24-hour sleep-wake rhythm disorder

Non-24-h sleep-wake rhythm disorder is quite rare in sighted patients and frequently associated with psychiatric disorders. We report the case of a 46-year-old man with autism spectrum disorder (ASD) and agoraphobia who had been referred for a suspicion of obstructive sleep apnea syndrome (OSAS). Polysomnography and arterial blood gas confirmed moderate OSAS associated with hypoventilation. Continuous positive airway pressure (CPAP) was started on fixed mode with excellent results. At follow-up, his CPAP report data revealed an irregular sleep-wake rhythm with a progressive offset of sleep schedule and wake time delayed from 1 h from day to day. Melatonin (or agonist) is efficacious and safe for long-term treatment in ASD and circadian rhythm sleep-wake disorder (CRSWD) with light therapy and wakefulness promoting medication. This case underlines the importance to sensitise psychiatrists to sleep and CRSWD, and also that CPAP data offer a possible objective alternative to sleep diary.

Automated summary

This case report describes a 46-year-old man with autism spectrum disorder (ASD) and agoraphobia who was referred for suspected obstructive sleep apnea syndrome (OSAS). Polysomnography confirmed moderate OSAS associated with hypoventilation, and treatment with continuous positive airway pressure (CPAP) showed excellent results. However, follow-up revealed an irregular sleep-wake rhythm, which was effectively treated with melatonin and light therapy. This case highlights the importance of addressing sleep and circadian rhythm sleep-wake disorders (CRSWD) in individuals with psychiatric disorders, and suggests that CPAP data could be an objective alternative to sleep diary.